Images in Clinical Medicine
Pneumopericardium and Pneumothorax
N Engl J Med 2009; 361:510July 30, 2009
- Article
A 60-year old man presented with progressive dyspnea 3 months after undergoing uncomplicated aortic-valve replacement and mitral-valve repair for valvular insufficiency related to previous endocarditis. A chest radiograph obtained on presentation (Panel A) revealed a large pleural effusion on the right side (arrow) and an increase in the cardiac silhouette (arrowhead). Computed tomography confirmed the presence of the pleural effusion and revealed a moderate pericardial effusion. Ultrasound-guided insertion of a pigtail drainage catheter into the pleural effusion was performed, and 2.8 liters of exudative pleural fluid was removed. A chest radiograph obtained after the procedure (Panel B) showed a large pneumothorax on the right side (black arrows), with associated atelectasis in the lower lobe, as well as a large pneumopericardium (white arrows). Percutaneous drainage was continued, and the patient was subsequently treated with a regimen of antiinflammatory drugs and colchicine for the postpericardiotomy syndrome. The patient was discharged in good condition and has subsequently done well.
Jason Andrade, M.D.
Eve Aymong, M.D.
St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
